Provider Demographics
NPI:1275914152
Name:EAST SIDE SOCIAL
Entity Type:Organization
Organization Name:EAST SIDE SOCIAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:KIMIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEHRANI
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA
Authorized Official - Phone:917-680-5805
Mailing Address - Street 1:85 DELANCEY ST
Mailing Address - Street 2:SUITE 13
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-3182
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:85 DELANCEY ST
Practice Address - Street 2:SUITE 13
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-3182
Practice Address - Country:US
Practice Address - Phone:917-680-5805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health